15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral

Name of the Procedure:

Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral.

Summary

This surgical procedure involves creating a flap of skin and tissue (called a pedicle) which is later used to reconstruct areas such as the eyelids, nose, ears, lips, or the inside of the mouth. The pedicle can either remain attached at one end (direct) or be formed into a tube to optimize blood flow before being transferred to the affected area.

Purpose

The procedure aims to repair or reconstruct facial features or oral structures after trauma, surgery, or congenital deformities. The goal is to restore both function and appearance, enhancing the patient's quality of life.

Indications

• Severe trauma or injury to facial structures
• Congenital deformities affecting facial or oral areas
• Tumor removal that results in significant tissue loss
• Conditions causing functional impairment, such as difficulty in eating, speaking, or seeing

Preparation

• Patients may need to fast for several hours before surgery.
• Pre-operative blood tests and imaging studies may be required.
• Discontinue certain medications as advised by the doctor.

Procedure Description

1. The surgeon identifies a donor site for the pedicle on the patient’s body.
2. A flap of skin and tissue is carefully shaped and, if needed, formed into a tube.
3. The pedicle is either left attached at one end (direct) or fully prepared for transfer.
4. Once ready, the pedicle is moved to the target area (eyelid, nose, ear, lip, intraoral regions).
5. The surgeon meticulously connects the pedicle to the defect site, ensuring proper blood flow.
6. The new tissue is sutured in place, and dressings are applied to protect the area.

Tools: Scalpels, sutures, microvascular instruments, surgical drapes. Anesthesia: General or local anesthesia depending on the extent of the procedure.

Duration

Typically, the procedure takes 3 to 6 hours, depending on complexity and reconstruction extent.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Plastic or reconstructive surgeon
• Anesthesiologist
• Surgical nurses
• Possibly, a microvascular specialist

Risks and Complications

Common risks include infection, bleeding, and scarring. Rare complications might involve tissue necrosis, flap failure, or abnormal scar formation. Management includes antibiotics, revision surgery, or additional wound care.

Benefits

Restoration of normal appearance and function of the affected facial or oral structures. Benefits can be realized within weeks to months, depending on the healing process.

Recovery

• Follow all post-operative care instructions, including wound care and medication.
• Avoid strenuous activities and follow specific restrictions as advised by the surgeon.
• Regular follow-up appointments to monitor healing.
• Full recovery typically takes several weeks to months.

Alternatives

• Skin grafts
• Free flaps (tissue transplanted with its own blood supply)
• Prosthetic devices
• Each alternative has its pros and cons concerning the procedure's complexity, recovery time, and success rate.

Patient Experience

During the procedure, the patient is under anesthesia, so they will not feel pain. Post-procedure, patients might experience discomfort, pain, swelling, and bruising, which are managed with pain relief medications and proper care. It’s important to adhere to the surgeon’s instructions for optimal recovery and outcomes.